In a single-institution study reported in the Journal of Clinical Oncology, Alderuccio et al found that not achieving complete remission (CR) after initial treatment, elevated lactate dehydrogenase (LDH), and more than four nodal sites at marginal zone lymphoma diagnosis are predictive of transformation to higher-grade lymphoma.

Study Details

The study involved data from 453 patients with marginal zone lymphoma seen at the University of Miami Sylvester Comprehensive Cancer Center between 1995 and 2016. Cumulative incidence rates of higher-grade transformation were estimated using competing risk methods, with death as the competing risk.

Risk Factors for Higher-Grade Transformation

Of the 453 patients, 34 (7.5%) had higher-grade transformation to diffuse large B-cell lymphoma, with 7 of these (21%) diagnosed at the time of marginal zone lymphoma diagnosis. Among the 27 patients with incident higher-grade transformation, median time to transformation was 29 months (range = 1.3–135 months). Increased risk of higher-grade transformation was associated with nodal/splenic marginal zone lymphoma (subdistribution hazard ratio [SHR] = 2.60, P = .023).

The investigators concluded, “Failure to achieve CR after initial treatment, elevated lactate dehydrogenase, and more than four nodal sites at the time of [marginal zone lymphoma] diagnosis are the main predictors of increased risk of [higher-grade transformation]. Patients with [higher-grade transformation] have shorter [overall survival].”

The study was supported by the Dwoskin, Recio and Anthony Rizzo Family Foundations and Jaime Erin Follicular Lymphoma Research Consortium.

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